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Prospective Payment System (PPS) Settlement Manual Tennessee Providersrev. July 2024Table of Contents Purpose & Background.....................................................................................3

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How to fill out prospective payment system pps

01

Gather patient information including demographics, diagnosis, and treatment plan.

02

Review the applicable payment categories under the Prospective Payment System (PPS).

03

Determine the appropriate payment classification using the coding system, such as ICD-10 or CPT codes.

04

Complete the necessary documentation required by the PPS, ensuring accuracy and completeness.

05

Submit the claim electronically or via paper as required, following the guidelines set by Medicare or the relevant payer.

06

Monitor the claim status and address any denials or additional requests from the payer.

Who needs prospective payment system pps?

01

Healthcare providers including hospitals and outpatient facilities that bill Medicare or Medicaid.

02

Patients receiving treatment that falls under the Prospective Payment System, particularly in rehabilitation, long-term care, and acute care settings.

03

Financial and administrative staff within healthcare facilities managing billing and compliance.

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What is prospective payment system pps?

The Prospective Payment System (PPS) is a method of reimbursement in healthcare that pays providers a predetermined amount based on the service provided, rather than actual costs incurred.

Who is required to file prospective payment system pps?

Hospitals and other healthcare facilities that are eligible for reimbursement under Medicare and certain other programs are required to file under the Prospective Payment System.

How to fill out prospective payment system pps?

Filling out the PPS involves completing the required CMS forms with accurate patient data, diagnoses, and treatment information, and submitting this data through the Medicare electronic claims processing system.

What is the purpose of prospective payment system pps?

The purpose of the Prospective Payment System is to control healthcare costs and to ensure that reimbursement is based on standardized rates rather than actual costs, encouraging efficiency and cost-effectiveness in patient care.

What information must be reported on prospective payment system pps?

Hospitals must report patient demographics, admission and discharge dates, diagnosis codes, procedure codes, and any other relevant data that supports the services provided during the hospital stay.

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